Clinical outcomes of early gastric cancer with lateral margin positivity after endoscopic submucosal dissection

Han, Jae Pil; Hong, Su Jin; Choi, Moon Han; Song, Jeong-Yeop; Kim, Hee Kyung; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung

doi:10.1016/j.gie.2013.06.030

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…In cases with positive horizontal margins, additional operation or re-ESD is recommended with a confirmation rate higher than 20 % after incomplete resection [4][5][6][7][8][9][10][11][12]. However, if the risk of lymph node metastasis is low, close surveillance is also recommended [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection

Noh

Kim

et al. 2014

Surg Endosc

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection

Noh

Kim

et al. 2014

Surg Endosc

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“…Therefore, to determine whether endoscopic treatment is indicated for a particular lesion, it is necessary to diagnose (i) histologic type, (ii) size, (iii) invasion depth, and (iv) ulcer presence or absence. In particular, because the lateral margin of the resected specimen positive for cancer cells indicates non‐curative resection, it is necessary to determine the exact horizontal extent of invasion 5–10 . A close endoscopic examination prior to treatment should be performed at the same time as the detection of gastric cancer or on another occasion by a specialist if only an insufficient endoscopic diagnosis is obtained at the time of the detection of gastric cancer.…”

Section: [Iv] Diagnosis To Choose the Therapeutic Strategy For Gastrimentioning

confidence: 99%

Guidelines for endoscopic diagnosis of early gastric cancer

Yao

Uedo

Kamada

et al. 2020

Digestive Endoscopy

122

144

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The Japan Gastroenterological Endoscopy Society developed the Guideline for Endoscopic Diagnosis of Early Gastric Cancer based on scientific methods. Endoscopy for the diagnosis of early gastric cancer has been acknowledged as a useful and highly precise examination, and its use has become increasingly more common in recent years. However, the level of evidence in this field is low, and it is often necessary to determine recommendations based on expert consensus only. This clinical practice guideline consists of the following sections to provide the current guideline: [I] Risk stratification of gastric cancer before endoscopic examination, [II] Detection of early gastric cancer, [III] Qualitative diagnosis of early gastric cancer, [IV] Diagnosis to choose the therapeutic strategy for gastric cancer, [V] Risk stratification after endoscopic examination, and [VI] Surveillance of early gastric cancer.

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“…[6][7][8] The guidelines also recommend nonsurgical management, such as additional endoscopic treatment or close observation without further treatment, as an alternative option for differentiated-type EGC in which a cancer-positive horizontal resection margin is the only noncurative factor, because of a very low risk of LN metastasis. 2,[9][10][11] In a previous study, no LN or distant metastasis or gastric cancer-related death occurred among 75 patients with differentiated-type EGC with a positive horizontal margin (HM) as the only noncurative factor during a median follow-up of 60 months. 12 However, no such guidelines are available on the nonsurgical management for undifferentiated EGC with positive HM after ER.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection

Yang

Lee

et al. 2021

Gut and Liver

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Background/Aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management. Methods:From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.

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Clinical outcomes of early gastric cancer with lateral margin positivity after endoscopic submucosal dissection

Cited by 12 publications

References 12 publications

Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection

Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection

Guidelines for endoscopic diagnosis of early gastric cancer

Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection

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